MACRA? MPP can help.

Payment Reform is fast approaching with the first baseline measurement period of MACRA (Medicare Access and Chip Re-authorization Act) starting in calendar year 2017 which will affect payment adjustments in 2019.

In two prior newsletters titled “Are you Ready for Payment Reform” and “Medicare Payment Innovations”; MPP has provided education on payment reform and MACRA which includes MIPS (Merit-Based Payment System) and APMs (Alternative Payment Models). This third newsletter in the series will provide an update on the newly released proposed rules for MACRA.

In brief, MACRA provides two new payment tracks: MIPS and APM. As stated in the prior newsletters; the traditional FFS (Fee-For-Service) payment model is going away and payment will now include some tie to value-based performance.

For scoring weights and annual changes; see the infographic below from The Advisory Board Company

Merit-Based Incentive Payment System.

Medical homes are recognized if they are accredited by: the Accreditation Association for Ambulatory Health Care; the National Committee for Quality Assurance (NCQA) PCMH recognition; The Joint Commission Designation, or the Utilization Review Accreditation Commission (URAC).

MPP will be expanding its Patient-Centered Medical Homes program and will be seeking NCQA certification

Use of the MPP supported patient disease registry, MD Insight from Symphony Performance Health, will assist with chronic disease management and patient care gap closure which will improve performance on HEDIS based metrics. This will prepare providers for quality measure performance reporting in the MIPS track.

Development of a care coordination model which will assist with Cost/Resource Use and Clinical Practice Improvement categories by helping to manage transitions of care opportunities, decreased unnecessary utilization and enabling the provision of care in the appropriate setting at the right time.

Creation of a tiered-membership model based on quality and efficiency thereby encouraging providers to utilize higher performing specialists and PCP’s.

MPP is investigating MIPS reporting solutions for MPP members not participating in the ACO

Investigate, develop and support solutions such as Cerner HealtheIntent population health platform to capture quality metrics and other data to meet Medicare, Blue Cross and Medicaid reporting requirements.

Physician Payment Timeline

MACRA | Medicare Access and CHIP Reauthorization Act of 2015

Legend

The projected 0.5% update, established by MACRA, was negated due to other legislative provisions. As a result, the 2016 conversion factor will be $35.93, which is a net reduction of 11 cents per Relative Value Unit (RVU).